Metabolism and Pathophysiology of Bariatric Surgery. Nutrition, Procedures, Outcomes and Adverse Effects

613 Pages·2016·36.47 MB·English

by  Victor R. Preedy

Metabolism and Pathophysiology
of Bariatric Surgery
Metabolism
and Pathophysiology
of Bariatric Surgery
Nutrition, Procedures, Outcomes,
and Adverse Effects
Victor R. Preedy
King’s College London, London, United Kingdom
Rajkumar Rajendram
Stoke Mandeville Hospital, Aylesbury, United Kingdom;
King’s College London, London, United Kingdom;
King Abdulaziz Medical City, Ministry of National Guard Hospital Affairs,
Riyadh, Saudi Arabia
Colin R. Martin
Buckinghamshire New University, Middlesex, United Kingdom
AMSTERDAM(cid:1)BOSTON(cid:1)HEIDELBERG(cid:1)LONDON(cid:1)NEWYORK(cid:1)OXFORD(cid:1)PARIS
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List of Contributors
Barham Abu Dayyeh, Mayo Clinic, Rochester, MN, LucaBusetto, PadovaUniversityHospital,Padova,Italy
UnitedStates
Virginia F. Byron, Ben-Gurion University of the Negev,
AndresAcosta, MayoClinic,Rochester,MN,UnitedStates Be’er-sheva,Israel
Sanjay Agrawal, Homerton University Hospital NHS StefaniaCamastra, UniversityofPisa,Pisa,Italy
Foundation Trust & Honorary, London, United
Michael Camilleri, Mayo Clinic, Rochester, MN, United
Kingdom
States
Varun Agrawal, University of Vermont College of
Guilherme M. Campos, Virginia Commonwealth
Medicine,Burlington,VT,UnitedStates
University,Richmond,VA,UnitedStates
NicholasAlexakis, UniversityofAthens,Athens,Greece
MariliaCarabotti, University“Sapienza”,Rome,Italy
Martin A. Alpert, University of Medicine-Columbia
JosephCaruana, ECMC,Buffalo,NY,UnitedStates
SchoolofMedicine,Columbia,MO,UnitedStates
Daniela S. Casagrande, Hospital de Clinicas de Porto
Abdallah Al-Salameh, Hoˆpital Biceˆtre, Le Kremlin-
Alegre,PortoAlegre,RS,Brazil
Biceˆtre, France; Assistance Publique-Hoˆpitaux de
Paris,Paris,France Stephanie Cassin, Ryerson University, Toronto, ON,
Canada
Konstantinos G. Apostolou, Laiko General Hospital,
Athens,Greece Everton Cazzo, State University of Campinas
(UNICAMP),Campinas,Brazil
Ali Ardestani, Harvard Medical School, Boston, MA,
United States; Brigham and Women’s Hospital, Francesco S. Celi, Virginia Commonwealth University,
Boston,MA,UnitedStates Richmond,VA,UnitedStates
Ibrahim Aslan, Research and Education Hospital, Elinton A. Chaim, State University of Campinas
Antalya,Turkey (UNICAMP),Campinas,Brazil
Mutay Aslan, Akdeniz University Medical Faculty, Ron Charach, Ben-Gurion University of the Negev,
Antalya,Turkey. Be’er-sheva,Israel
BrennoAstiarraga, UniversityofPisa,Pisa,Italy Gabriela V. Chaves, Brazilian National Cancer Institute,
RiodeJaneiro,RJ,Brazil
Molly Atwood, Ryerson University, Toronto, ON,
Canada Prasanth K. Chelikani, University of Calgary, Calgary,
AB,Canada
Alfonso Barbarisi, Second University of Naples, Naples,
Italy Mingyi Chen, Davis Medical Center, Sacramento, CA,
UnitedStates
Mohamed Bekheit, El Kabbary general Hospital,
Alexandria,Egypt EvaM.Conceic¸a˜o, UniversidadedoMinho,Braga,Portugal
Josiah Billing, Eviva Bariatrics, Edmonds, WA, United Louise Crovesy, Federal University of Rio de Janeiro,
States RiodeJaneiro,RJ,Brazil
Peter Billing, Eviva Bariatrics, Edmonds, WA, United Paresh Dandona, State University of New York at
States Buffalo,Buffalo,NY,UnitedStates
Giuseppe Boldrini, Catholic University Medical School, Nickolas Dasher, University of Michigan, Ann Arbor,
Roma,Italy MI,UnitedStates
Phillip J. Brantley, Pennington Biomedical Research Lauren David, Ryerson University, Toronto, ON,
Center,BatonRouge,LA,UnitedStates Canada
xxi
xxii ListofContributors
Dafydd A. Davies, The IWK Children’s Health Centre, Marinos Fysekidis, Assistance Publique-Hoˆpitaux de
Halifax,NS,Canada Paris,Paris,France;HoˆpitalAvicenne,Bobigny,France
Mariane de Almeida Cardeal, Gastrocirurgia de AlfredoGenco, LaSapienzaUniversity,Rome,Italy
Bras´ılia,Brasilia,DF,Brazil
IreneGenerali, UniversityofParma,Parma,Italy
Loek J.M. de Heide, Medical Centre Leeuwarden,
InaGesquiere, UniversityHospitalsLeuven/KULeuven,
Leeuwarden,TheNetherlands
Leuven,Belgium
Marcela F. de Novais, Gastrocirurgia de Bras´ılia,
Husam Ghanim, State University of New York at
Brasilia,DF,Brazil
Buffalo,Buffalo,NY,UnitedStates
Maria R.M. de Oliveira, Bioscience Institute of the
Noyan Gokce, Boston University School of Medicine,
University Ju´lio de Mesquita Filho, UNESP, Botucatu,
Boston,MA,UnitedStates
SP,Brazil
Nicolas Goossens, University Hospital Geneva, Geneva,
ChiaraDePanfilis, UniversityofParma,Parma,Italy
Switzerland; Tisch Cancer Institute, New York, NY,
Elizabeth Dettmer, Hospital for Sick Children, Toronto, UnitedStates
ON,Canada Ralph Green, Davis Medical Center, Sacramento, CA,
Parag Dhumane, Lilavati Hospital and Research Center, UnitedStates
Mumbai,India Jan Willem M. Greve, Medical Director Obesity Clinics
Fernando Dip, Cleveland Clinic Florida, Weston, FL, South, Heerlen, The Netherlands; Zuyderland Medical
UnitedStates Center,Heerlen,TheNetherlands
GianfrancoDonatelli, HoˆpitalPrive´ des Peupliers,Paris, Win Guan, Pennington Biomedical Research Center,
France BatonRouge,LA,UnitedStates
Dana L. Duren, University of Missouri, Columbia, MO, Jill Hamilton, Hospital for Sick Children, Toronto, ON,
UnitedStates Canada
Luzia J. Hintze, University of Ottawa, Ottawa, ON,
Shenelle Edwards-Hampton, Wake Forest Baptist
Canada
MedicalCenter,Winston-Salem,NC,UnitedStates
Tomas Javier Birriel, St. Luke’s University Hospital
Maher El Chaar, St. Luke’s University Hospital and
andHealthNetwork,Allentown,PA,UnitedStates
HealthNetwork,Allentown,PA,UnitedStates
Amanda M. Johner, The Oregon Clinic and Legacy
AtharS.Elward, CairoUniversity,Giza,Egypt
Weight&DiabetesInstitute,Portland,OR,UnitedStates
Marloes Emous, Medical Centre Leeuwarden,
Minoa Jung, University Hospital Geneva, Geneva,
Leeuwarden,TheNetherlands
Switzerland
Roberto Fabris, Padova University Hospital, Padova,
Jan P. Kamin´ski, University of Illinois Metropolitan
Italy
GroupsHospitals,Chicago,IL,UnitedStates
Melissa G. Farb, Boston University School of Medicine,
Natraj Katta, University of Medicine-Columbia School
Boston,MA,UnitedStates
ofMedicine,Columbia,MO,UnitedStates
Gil Faria, Hospital de Santo Anto´nio, Porto, Portugal;
Jedediah Kaufman, Eviva Bariatrics, Edmonds, WA,
Abel Salazar Biomedical Sciences Institute, Porto,
UnitedStates
Portugal
Silvana M.B. Kelles, Hospital das Cl´ınicas da
Orlando P. Faria, Gastrocirurgia de Bras´ılia, Brasilia,
Universidade Federal de Minas Gerais, Belo
DF,Brazil
Horizonte,MinasGerais,Brazil
Silvia L. Faria, University of Brasilia, Brasilia, DF,
Muhammad Faisal Khan, Aga Khan University
Brazil
Hospital,Karachi,Pakistan
ConstantinosFedonidis, BRFAA,Athens,Greece
Timothy R. Koch, MedStar-Washington Hospital
Andrew W. Froehle, Wright State University Boonshoft Center, Washington, DC, United States; Center for
SchoolofMedicine,Kettering,OH,UnitedStates Advanced Laparoscopic General & Bariatric Surgery,
Washington,DC,UnitedStates
Michael S. Furman, Warren Alpert Medical School of
Brown University, Providence, RI, United States; Katerina Kotzampassi, Aristotle’s University of
RhodeIslandHospital,Providence,RI,UnitedStates ThessalonikiSchoolofMedicine,Thessaloniki,Greece
ListofContributors xxiii
Marcin Krawczyk, Saarland University Medical Center, Scott Monte, School of Pharmacy & Pharmaceutical
Homburg, Germany; Medical University of Warsaw, Sciences,Amherst,NY,UnitedStates
Warsaw,Poland
Claudio Cora Mottin, Hospital de Clinicas de Porto
Blandine Laferre`re, Columbia University College of Alegre,PortoAlegre,RS,Brazil
PhysiciansandSurgeons,NewYork,NY,UnitedStates
Giuseppe Nanni, Catholic University Medical School,
Frank Lammert, Saarland University Medical Center, Roma,Italy
Homburg,Germany
Nelson Nardo, State University of Maringa´, Maringa´,
Jacob C. Langer, Hospital for Sick Children, Toronto, PR,Brazil
ON,Canada
Anand Nath, MedStar-Washington Hospital Center,
Derek Larkin, Edge Hill University, Ormskirk, United Washington,DC,UnitedStates
Kingdom
Manoel G. Neto, Gastro Obeso Center and Mario Covas
Richard T. Laughlin, Wright State University Hospital, Sa˜o Paulo, SP, Brazil; Florida International
Boonshoft School of Medicine, Dayton, OH, United University, Miami, FL, United States; ABC Medical
States School,SantoAndre,Brazil
Belinda Lennerz, Boston Children’s Hospital, Boston, Alex Ordonez, Previty Clinic, Beaumont, TX, United
MA,UnitedStates States
Roman Liebe, Saarland University Medical Center, Jose´ C. Pareja, State University of Campinas
Homburg,Germany (UNICAMP),Campinas,SP,Brazil
Carolina Llavero, Electrostimulation Unit, Garcilaso Alfons Pomp, New York Presbyterian(cid:1)Weill Cornell
Clinic,Madrid,Spain MedicalCollege,NewYork,NY,UnitedStates
Emanuele Lo Menzo, Cleveland Clinic Florida, Weston, Victor R. Preedy, King’s College London, London,
FL,UnitedStates UnitedKingdom
G.Lopez-Nava, Madrid Sanchinarro University Hospital, Mina Y. Price, Royal Free London NHS Foundation
Madrid,Spain;SanPabloUniversityofMadrid(CEU), Trust,London,UnitedKingdom
Madrid,Spain
Hong Qiu, Davis Medical Center, Sacramento, CA,
Michele Lorenzo, ASL NA 3 SUD, Torre Annunziata, UnitedStates
Italy
Karina Quesada, University of Mar´ılia, Mar´ılia, SP,
William Lynn, Homerton University Hospital NHS
Brazil
FoundationTrust,London,UnitedKingdom
Rajkumar Rajendram, Stoke Mandeville Hospital,
Fernanda C.C.M. Magno, Federal University of Rio de
Aylesbury, United Kingdom; King’s College London,
Janeiro,RiodeJaneiro,RJ,Brazil
London, United Kingdom; King Abdulaziz Medical
Ajay V. Maker, University of Illinois Metropolitan City, Ministry of National Guard Hospital Affairs,
Groups Hospitals, Chicago, IL, United States; Riyadh,SaudiArabia
University of Illinois at Chicago, Chicago, IL, United
Yudi P.G. Ramirez, School of Pharmacological
States
Sciences of the University Ju´lio de Mesquita Filho,
Vijay K. Maker, University of Illinois Metropolitan UNESP,Araraquara,SP,Brazil
Groups Hospitals, Chicago, IL, United States;
Irineu Rasera, Center of Excellence in Bariatric Surgery
University of Illinois at Chicago, Chicago, IL, United
ofPiracicaba,Piracicaba,SP,Brazil
States
Michele N. Ravelli, School of Pharmacological Sciences
DimitraMangoura, BRFAA,Athens,Greece
of the University Ju´lio de Mesquita Filho, UNESP,
Colin R. Martin, Buckinghamshire New University, Araraquara,SP,Brazil
Middlesex,UnitedKingdom
Kevin M. Reavis, The Oregon Clinic and Legacy Weight
Christophe Matthys, University Hospitals Leuven/KU &DiabetesInstitute,Portland,OR,UnitedStates
Leuven,Leuven,Belgium
D.D. Rosa, Hospital de Clinicas de Porto Alegre, Porto
Milene Moehlecke, Hospital de Clinicas de Porto Alegre,RS,Brazil
Alegre,PortoAlegre,RS,Brazil
Eliane L. Rosado, Federal University of Rio de Janeiro,
VioletaMoize´, HospitalClinic,Barcelona,Spain RiodeJaneiro,RJ,Brazil
xxiv ListofContributors
Raul J. Rosenthal, Cleveland Clinic Florida, Weston, Lee L. Swanstrom, Oregon Health and Sciences
FL,UnitedStates University, Portland, OR, United States; Institut
HopitaloUniversitaire,Strasbourg,France
Jaime Ruiz-Tovar, Electrostimulation Unit, Garcilaso
Clinic,Madrid,Spain Lori B. Sweeney, Virginia Commonwealth University,
Richmond,VA,UnitedStates
Giuseppe Scalera, Second University of Naples, Naples,
Italy David W. Swenson, Warren Alpert Medical School of
Brown University, Providence, RI, United States;
BeatrizD.Schaan, HospitaldeClinicasdePortoAlegre,
RhodeIslandHospital,Providence,RI,UnitedStates
PortoAlegre,RS,Brazil
Samuel Szomstein, Cleveland Clinic Florida, Weston,
Luigi Schiavo, Second University of Naples, Naples,
FL,UnitedStates
Italy
Ali Tavakkoli, Harvard Medical School, Boston, MA,
Deepa Sekhar, University of Calgary, Calgary, AB,
United States; Brigham and Women’s Hospital,
Canada
Boston,MA,UnitedStates
Roberto Serra, Padova University Hospital, Padova,
Renee M. Tholey, New York Presbyterian(cid:1)Weill
Italy
Cornell Medical College, New York, NY, United
CarolaSeveri, University“Sapienza”,Rome,Italy
States
Eyal Sheiner, Ben-Gurion University of the Negev,
Andre P. van Beek, University Medical Centre
Be’er-sheva,Israel
Groningen,Groningen,TheNetherlands
Richard J. Sherwood, University of Missouri,
Bart Van der Schueren, University Hospitals Leuven/
Columbia,MO,UnitedStates
KULeuven,Leuven,Belgium
Eric G. Sheu, Harvard Medical School, Boston, MA,
Roberto Vettor, Padova University Hospital, Padova,
United States; Brigham and Women’s Hospital,
Italy
Boston,MA,UnitedStates
JosepVidal, HospitalClinic,Barcelona,Spain
Timothy R. Shope, MedStar-Washington Hospital
Kristen L. Votruba, University of Michigan, Ann
Center, Washington, DC, United States; Georgetown
Arbor,MI,UnitedStates
University School of Medicine, Washington, DC,
UnitedStates Martin Wabitsch, Ulm University Medical Center, Ulm,
Germany
AnneD.Shrewsbury, WestSussex,UnitedKingdom
Sharlene Wedin, Medical University of South Carolina,
Jacqueline S. Silva, Federal University of Rio de
Charleston,SC,UnitedStates
Janeiro,RiodeJaneiro,RJ,Brazil
GeorgeStavrou, Thessaloniki,Greece
Foreword
Having trainedand worked intwo ofthelargestbariatriccenters inthe United Kingdom (King’s College HospitalNHS
Foundation Trust and Imperial Healthcare NHS Trust, London), within both clinical and academic settings, I fully
appreciatetheenormityofthechallengeobesityposestohealthcaresystems.
The World Health Organization (WHO) estimated that globally, in 2014, more than 1.9 billion adults were over-
weight and more than half a billion were obese. The prevalence more than doubled between 1980 and 2014. Obesity,
which wasonceassociatedonlywith high-incomecountries, isnowalsoprevalentinlow- andmiddle-incomecountries
as well. Furthermore, overweight children are likely to become obese adults, thus, childhood obesity and overweight is
one of the most serious public health challenges of the 21st century. Obesity and overweight can have a variety of
adversehealthconsequencesandmetaboliceffectsassociatedwithahighrateofdeath,suchastype2diabetesmellitus,
hypertension, dyslipidemia, obstructive sleep apnea, steatohepatitis, and certain types of cancer. It is estimated that
around 65% of the world’s population lives in a country where overweight and obesity kills more people than
underweight.
The huge economic burden to the health systems across the world highlights the importance of collectively addres-
sing this global epidemic. Currently, bariatric (weight loss) surgery has become the only long-term effective treatment
for severe (morbid) obesity, as calorie-restricted diets and drug therapy have had disappointing results for weight loss.
Remarkably, bariatric surgery not only helps to achieve significant and sustained weight loss, but also leads to multiple
metabolic benefits. Thus, the consensus among experts in the field is to refer to bariatric surgery as “metabolic sur-
gery.” Over the past decade, there has been a significant global rise in basic science and translational research studies
looking into the pathophysiology of bariatric surgery, which potentially holds the key to the long-term management of
this epidemic. With all its merits in contributing to metabolic improvements, bariatric surgery is also associated with
complicationsthatcanbedevastatingifnotmanagedappropriatelyinwell-establishedbariatriccentersofexcellence.
This book, “Pathophysiology of Bariatric Surgery: Metabolism, Nutrition Procedures, Outcomes, and Adverse
Effects,” takes the reader on a journey through the complex world of obesity, highlighting that there is more to obesity
than excess weight or an expanding waistline. The authors provide an in-depth review of how weight contributes to
obesity-related comorbidities, and the rationale behind the different surgical procedures used. There is also comprehen-
sive insight into the nutritional and metabolic complications, as well as the much-neglected psychological and behav-
ioral aspects, of obesity before and after bariatric surgery. Ideally, the intended audience will appreciate and relate to
the multiple challenges faced by obese patients in dealing with their physical and mental health issues as they weigh
the favorable results and adverse outcomes of bariatric surgery. Ultimately, it is a life-changing surgical intervention
thatleadstoeithereuphoriaordespair.
The content of this book is relevant and current to my own clinical practice and obesity-related research, which
makes it a timely publication. It is intended to be both informative and easy to read as an important reference for clini-
cians,alliedhealthprofessionals,students,andallthoseinterestedinthecomplexityandmanagementofobesity.
Dr.RoyceP.Vincent,MBBS,MSc,EuSpLM,FRCPath,MD
ConsultantChemicalPathologistandClinicalLead,DepartmentofClinicalBiochemistry,
King’sCollegeHospitalNHSFoundationTrust,London,UK
HonorarySeniorLecturer,DepartmentofNutritionandDietetics,King’sCollegeLondon,UK
xxv
Preface
In the United States, about one-third of the population are obese. While no state in the United States has an incidence
less than 20%, in some communities, 50% of the adult population may be obese. The adverse effects of obesity include
increasedcancerrates,metabolicsyndromeanddiabetes,heartdisease,stroke,sleepapnea,liverdisease,musculoskele-
tal problems, and various psychological changes. Thus, obesity can be considered a disease that affects not only the
individual,butthefamilyunit,thelocalcommunity,andthenationasawhole.Forexample,themedicalcostofobesity
intheUnitedStatesaloneis$150billionannually.
There are various strategies to reduce obesity. These include dietary changes, behavioral modifications (including
exercise), and drugs (that can cause malabsorption or alterations in satiety(cid:1)appetite signaling). However, they are not
alwayseffective,andatthatstagebariatricsurgerybecomesaviablealternative.
Bariatricsurgeryhasbeenshowntoimprovenumerouspsychological,metabolic,physiological,andfunctionalpara-
meters. These include quality of life measures, diabetes, hypertension, hyperlipidemia, and sleep apnea. However, there
are different types of bariatric surgery, including Roux-en-Y gastric bypass (RYGB), gastric banding, sleeve gastrec-
tomy (SG), biliopancreatic diversion (BPD), and other variations of these procedures. The various weight loss proce-
dures have different levels of popularity, outcomes, and success rates. Their effects on reducing obesity and
comorbidities are dissimilar as well. Dissimilar bariatric procedures also have variable cellular and tissue effects, as
wellasnutritionalcomplications.Itisthereforeclearthattherearecomplexinterrelationshipsbetweenobesityandmet-
abolic profiles before and after bariatric surgery. However, understanding these relationships has been difficult as the
information relating to nutrition, surgical procedures, outcomes, and side effects have never been marshaled into a sin-
gletext.PathophysiologyofBariatricSurgeryaddressesthisinacomprehensiveway.
Thebookhaseightsections:
1.FeaturesofObesityandStrategiesforWeightLoss
2.SurgicalandPostsurgicalProcedures
3.SafetyandOutcomes
4.Metabolism,Endocrinology,andOrganSystems
5.NutritionalAspects
6.Cardiovascular,BodyComposition,andPhysiologicalAspects
7.PsychologicalandBehavioralAspects
8.Resources
TheEditorsrecognizethedifficultiesinassigningsomechapterstodifferentsections.Veryoftenchapterscoverdif-
ferent scientific domains, and they could equally fit into one of several sections of the book. However, this is resolved
bytheexcellentindexingsystemcompiledbyElsevier.
NovelfeaturesineachchapterincludeaMini-DictionaryofTerms,KeyFacts,andSummaryPoints.
Contributors are authors of international and national standing, leaders in the field, and trendsetters. The emerging
fields of obesity and bariatric surgery, as well as important discoveries relating to diet and nutritional health, are also
incorporated in Pathophysiology of Bariatric Surgery. This represents essential reading for nutritionists, dietitians, sur-
geons, health care professionals, research scientists, molecular and cellular biochemists, physicians, general practi-
tioners,publichealthworkers,andanyoneinterestedinwell-beingingeneral.
Editors
RajkumarRajendram,VictorR.Preedy&ColinR.Martin
xxvii
Chapter 1
Obesity and Cardiac Failure:
Pathophysiology, Epidemiology, Clinical
Manifestations, and Management
M.A.Alpert andN.Katta
UniversityofMedicine-ColumbiaSchoolofMedicine,Columbia,MO,UnitedStates
LIST OF ABBREVIATIONS
BMI bodymassindex
CO cardiacoutput
HF heartfailure
HTN systemichypertension
LV leftventricular
LVEF leftventricularejectionfraction
LVH leftventricularhypertrophy
RAAS renin-angiotensin-aldosteronesystem
INTRODUCTION
The relation of obesity to heart disease has been a subject of interest since ancient times, but has been studied most
extensively during the past half century [1(cid:1)7]. Obesity affects the heart in multiple ways. However, the most intense
focus, as it relates to bariatric surgery, has been on the impact of obesity on cardiac performance and morphology and
itsrelationtoheartfailure(HF)[3(cid:1)7].Thepurposeofthischapteristoexploretheseissues.
CLASSIFICATION OF OBESITY
The World Health Organization classifies body weight on the basis of body mass index (BMI). Table 1.1 summarizes
the current and proposed body weight classifications. For purposes of this review, the term severe obesity will refer to
BMI $40.0kg/m2. Central obesity is commonly defined as waist circumference .102cm in men and .88cm in
women,orwaist(cid:1)hipratio .1.0inmenand $0.8inwomen.
CARDIAC PERFORMANCE AND MORPHOLOGY IN OBESITY
Obesity causes changes in cardiac performance that may produce alterations in cardiac morphology and impairment of
ventricular function in adults. Such maladaptation is most pronounced in severely obese persons, but may occur to a
lesser extent in overweight, class I or class II obese patients [1,3(cid:1)45]. These alterations in cardiac structure and func-
tion have also been reported in obese children and adolescents [1,3(cid:1)5]. The following comments on the effects of obe-
sityoncardiac performanceandmorphologyapplyprimarilytosevereobesity.
MetabolismandPathophysiologyofBariatricSurgery.
©2017ElsevierInc.Allrightsreserved. 3